ECG: Accelerated Idioventricular Rhythm

1. PROF .S. TITO’S UNIT
DR.Pandichelvan
ECG of the WEEK

2. Professor DR.TITO’ S unit
Ecg of the week
10:05

6. ECG shows
Sinus rhythm
Heart rate: 80/min
PR interval:140 msec
QRS duration: 80 msec
QT interval: 398 msec
QTc interval:453 msec
ST elevation in II,III, avf, V4R, V5R, V7, V8, V9.
ST depression in I, avL v4,v5

7. Post streptokinase
Sinus rhythm 11.30 pm
Heart rate- around 100/min
P wave absent
Qrs duration:128 msec
Qt interval: 425 msec
Qrs axis: around -30 degree

8. Accelerated Idio-ventricular rhythm
Increased ventricular automaticity
Benign rhythm.
Brief self limiting arrhythmia.
Seen in absence of any structural heart disease

9. Enhanced automaticty in bundle branch or fasciculation of
ventricular purkinjee system.
Abnormal QRS morphology with heart rate 50 to 110 per
minute
No preceding p waves.
During or after ante-grade ventricular activation, retro-
gradely conducted atrial activation seen. Inverted p waves
buried in large QRS complex or t wave.
rate of the cells which are located at distal end of the pace
making conducting system is low

10. Differential diagnosis
Dilated cardiomyopathy
Acute MI
Ischemic cardiomyopathy
Rheumatic heart disease
Acute coronary syndrome
Digitalis toxicity
Cocaine intoxication
Post cardiac surgery

11. Sustained AIVR seen in acute MI and post operative.
Occurs in 25% of STEMI
Occurs transiently during fibrinolytic therapy. Incidence is
8-46%
Considered non specific marker of reperfusion after
thrombolytic therapy.
The incidence of AIVR not affected by location or infarct size
Presence of AVIR after mi not associated with increased
mortality.

13. Thank you
Reference THE HEART –HURST
HARRISON
MARRIOT THE ECG